Medications for Bipolar Disorder

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor or according to the instructions provided. If you have further questions about medications or their potential side effects, contact your doctor.

Psychiatrists are medical doctors (MDs) with expertise in the diagnosis and treatment of disorders of mental health. They can prescribe medications for medical conditions including
bipolar disorder
. Some primary care doctors, who do not specialize in psychiatry, may also prescribe these medications. In less severe cases, they will treat patients in consultation with a psychiatrist.

Medications known as mood stabilizers are the mainstay of treatment used to help control the mood swings associated with bipolar disorder. Several different types of mood stabilizers are available. You may continue treatment with mood stabilizers for an extended period of time (years). Other medications are added when necessary, sometimes only for shorter periods of time, to treat acute episodes of mania or
depression
.

Lithium stabilizes your mood and is often used as initial treatment for preventing manic and depressive episodes. It acts on the central nervous system and helps you to have more control over your emotions. It has been the only medication consistently shown to be effective in preventing suicide in patients with mood disorders.

Do not drink large amounts of caffeinated beverages, such as coffee, tea, and colas when you are taking lithium.

Anticonvulsant medications, such as valproate (Depakote) or carbamazepine (Tegretol), can also have mood-stabilizing effects. They may be especially useful for difficult-to-treat bipolar episodes. In some people, anticonvulsant medications are combined with lithium, or with each other, for maximum effect.

Researchers are evaluating the safety and efficacy of psychotropic medications in children and adolescents, in light of their widespread use. There is some evidence that valproate may lead to adverse hormonal changes in teenage girls. It may also lead to
polycystic ovary syndrome
in women who began taking the medication before age 20. Young female patients taking valproate should be carefully monitored by their doctors.

Aseptic meningitis—inflammation of the layers of tissue that surround the brain

Liver injury

Pancreatitis

Bone marrow suppression, which causes a decrease in blood cells

Rash

Benzodiazepines

Clonazepam (Klonopin)

Lorazepam (Ativan)

There are many different types of benzodiazepine medications, including clonazepam (Klonopin) and lorazepam (Ativan). They can be helpful in promoting better sleep and reducing agitation. However, since these medications can be highly addictive and lead to tolerance, they are typically only prescribed on a short-term basis or for emergencies.

Possible side effects include:

Drowsiness

Lightheadedness, particularly in elderly persons

Antidepressants—Selective Serotonin Reuptake Inhibitors (SSRIs)

Citalopram (Celexa)

Fluvoxamine (Luvox)

Paroxetine (Paxil)

Fluoxetine (Prozac)

Sertraline (Zoloft)

Escitalopram (Lexapro)

Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in
depression
. They may occasionally be used in the treatment of bipolar disorder, in combination with other medications.

Serotonin syndrome, a serious medical condition caused by an overload of serotonin

Sedation or insomnia

Increase or decrease in appetite

Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Other Antidepressants

Bupropion (Wellbutrin)

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Mirtazapine (Remeron)

There are several other antidepressants that work in a variety of different ways and affect the concentrations of the neurotransmitters serotonin, norepinephrine, and dopamine, which are all known to be involved in the regulation of mood.

The exact mechanism of bupropion is poorly understood. But, it is thought to be mediated through norepinephrine and dopamine pathways. It is often used in patients who are depressed and unable to tolerate SSRIs. It is also sometimes used in the treatment of bipolar disorder, along with a mood stabilizer.

Possible side effects include:

Nausea

Nervousness

Appetite increase or decrease

Sedation or insomnia

Sexual dysfunction, not commonly experienced with Wellbutrin, but it is possible

Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Venlafaxine (Effexor) and Duloxetine (Cymbalta)
are in the class of medications called serotonin norepinephrine reuptake inhibitors (SNRIs). They work by increasing the amount of both serotonin and norepinephrine. SNRIs are considered a last option for treatment of bipolar disorder and should always be used in conjunction with a mood stabilizer.

Possible side effects include:

Nausea

Nervousness

Anxiety

Sexual dysfunction

Appetite increase or decrease

Increased blood pressure

Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Mirtazapine (Remeron), a tetracyclic antidepressant,
has a unique mechanism of action. The medication increases the release of norepinephrine from certain neurons through a complicated process.

Possible side effects include:

Sedation

Weight gain

Fatigue

Nausea

Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Atypical Antipsychotics

Clozapine (Clozaril)

Olanzapine (Zyprexa)

Risperidone (Risperdal)

Ziprasidone (Zeldox)

Quetiapine (Seroquel)

Aripiprazole (Abilify)

In some cases, atypical antipsychotic medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), are added to a medication routine to reduce manic symptoms. Quetiapine (Seroquel) has been shown to be effective in reducing the symptoms of both mania and depression in bipolar disorder.

Possible side effects include:

Weight gain, metabolism changes

Increase in cholesterol

Increase in blood sugar

Drowsiness

Lightheadedness

Constipation

Risk of severe mood and behavior changes, including suicidal thoughts in some people—young adults may be at a higher risk for this side effect

Combination (Atypical Antipsychotic and SSRI Antidepressant)

Another medication, called Symbyax, combines olanzapine and fluoxetine (Symbyax). This has both an atypical antipsychotic and an SSRI antidepressant.

Possible side effects include:

High blood sugar

Sedation

Lightheadedness, dizziness

Change in ability to think clearly

Diarrhea

Dry mouth

Weight gain

Risk of severe mood and behavior changes, including suicidal thoughts in some patients. (Young adults may be at a higher risk for this side effect.)

Special Note

Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the harmful effects of some mood stabilizing medications on the developing fetus. If you are considering breastfeeding your baby and will be taking medication at the same time, discuss the possible risks with your doctor before you start. If possible, these discussions should take place prior to a pregnancy. New treatments that have fewer side effects are being studied.

When to Contact Your Doctor

Contact your doctor if your medication does not seem to be working or if you have any side effects that are troublesome and persistent.

Special Considerations

If you are taking medications, follow these general guidelines:

Take your medication as directed. Do not change the amount or the schedule.

Do not stop taking your medication without talking to your doctor.

Do not share them.

Know the results and side effects of your medication. Report them to your doctor.

Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.

Plan ahead for refills so you don’t run out.

References

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273
.
Updated August 12, 2010. Accessed September 5, 2013.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.